Provider Demographics
NPI:1073770392
Name:HORN, TIM DOUGLAS (LPN)
Entity Type:Individual
Prefix:
First Name:TIM
Middle Name:DOUGLAS
Last Name:HORN
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4577 OLENTANGY RIVER RD APT G4
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-2449
Mailing Address - Country:US
Mailing Address - Phone:614-205-1101
Mailing Address - Fax:
Practice Address - Street 1:4577 OLENTANGY RIVER RD APT G4
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-2449
Practice Address - Country:US
Practice Address - Phone:614-205-1101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-22
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN126325164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse